NUR 242 MEDICAL SURGICAL NURSING EXAM 2
1.A client is scheduled for surgery and takes warfarin daily for
atrial fibrillation. Which preoperative action is most appropriate?
A) Continue warfarin as usual
B) Hold warfarin 5 days before surgery
C) Double the dose the day before surgery
D) Switch to enoxaparin 48 hours before surgery
Correct Answer: Hold warfarin 5 days before surgery
Rationale: Warfarin is typically held 5 days preoperatively to allow the INR to
return to a safe range, minimizing bleeding risk during surgery. This is a
standard perioperative medication management practice. Continuing or
doubling the dose increases hemorrhage risk, while switching to enoxaparin
is not the initial priority before confirming the hold.
2. Which medication should generally be continued through the
perioperative period to prevent rebound effects?
A) Metformin
B) Beta-blocker
C) Aspirin
D) Clopidogrel
Correct Answer: Beta-blocker
Rationale: Beta-blockers are continued perioperatively to prevent
tachycardia, hypertension, and myocardial ischemia from rebound
sympathetic stimulation. Metformin is often held due to lactic acidosis risk
with contrast, while aspirin and clopidogrel are held to reduce bleeding risk.
, 3. A client with diabetes is NPO for surgery. Which intervention best
manages their blood glucose during this period?
A) Hold all insulin until the client resumes eating
B) Administer a half-dose of long-acting insulin
C) Initiate an IV insulin infusion with frequent glucose checks
D) Give oral hypoglycemic with a sip of water
Correct Answer: Initiate an IV insulin infusion with frequent glucose checks
Rationale: For NPO diabetic clients, an IV insulin infusion with frequent
glucose monitoring prevents hyperglycemia and hypoglycemia. Holding
insulin risks hyperglycemia, while giving oral agents or half-doses without
monitoring is unsafe and imprecise.
4. In the immediate postoperative period, a client's temperature
drops to 35.8°C (96.4°F). Which complication is this client at
greatest risk for?
A) Malignant hyperthermia
B) Increased blood loss
C) Surgical site infection
D) Hyperactive bowel sounds
Correct Answer: Surgical site infection
Rationale: Perioperative hypothermia causes peripheral vasoconstriction and
decreased tissue oxygenation, impairing leukocyte function and increasing
surgical site infection risk. This is an evidence-based concern supported by
surgical quality metrics.
5. A client in the PACU following abdominal surgery is restless,
thrashing, tachycardic, and hypertensive. What is the priority
nursing action?
A) Administer a PRN antiemetic
, B) Apply soft wrist restraints
C) Assess for a distended bladder
D) Administer IV normal saline
Correct Answer: Assess for a distended bladder
Rationale: Sudden restlessness, tachycardia, and hypertension in the
immediate post-op period are often caused by a distended bladder from
urinary retention. Assessing and relieving bladder distention is the priority
before considering restraints or fluid boluses.
6. A client is receiving IV morphine via PCA pump and becomes
unresponsive with a respiratory rate of 6 breaths/min. What is the
priority intervention?
A) Apply a continuous pulse oximeter
B) Push the PCA demand button to assess response
C) Administer naloxone IV and prepare to ventilate
D) Check the PCA pump settings
Correct Answer: Administer naloxone IV and prepare to ventilate
Rationale: Opioid-induced respiratory depression is a medical emergency.
Naloxone reverses opioid effects, and ventilation support is needed until it
takes effect. Checking pump settings is important but secondary to
stabilizing the client.
7. A client with diabetic neuropathy reports burning and tingling
pain in their feet. Gabapentin is prescribed. Which statement best
explains the medication's action?
A) "It blocks pain receptors in your feet directly."
B) "It reduces inflammation around the nerves."
C) "It decreases abnormal electrical activity in damaged nerves."
D) "It releases endorphins to help you cope with pain."
, Correct Answer: "It decreases abnormal electrical activity in damaged
nerves."
Rationale: Gabapentin and pregabalin are adjuvant analgesics for
neuropathic pain. They bind to alpha-2-delta subunits of calcium channels,
modulating neurotransmitter release and reducing abnormal nerve firing.
8. A client with a large, open abdominal wound has red, granular
tissue in the wound bed. Which phase of wound healing is this
client experiencing?
A) Hemostasis
B) Inflammatory phase
C) Proliferative phase
D) Maturation phase
Correct Answer: Proliferative phase
Rationale: The proliferative phase is characterized by granulation tissue (red,
granular), angiogenesis, and epithelialization. Hemostasis occurs
immediately, inflammation lasts days, and maturation involves collagen
remodeling over months.
9. A client with a serum potassium of 2.7 mEq/L is prescribed
hydrochlorothiazide for hypertension. Which nursing action is
most appropriate?
A) Administer the medication as ordered
B) Hold the medication and notify the provider
C) Double the dose to improve effectiveness
D) Give the medication with orange juice
Correct Answer: Hold the medication and notify the provider
1.A client is scheduled for surgery and takes warfarin daily for
atrial fibrillation. Which preoperative action is most appropriate?
A) Continue warfarin as usual
B) Hold warfarin 5 days before surgery
C) Double the dose the day before surgery
D) Switch to enoxaparin 48 hours before surgery
Correct Answer: Hold warfarin 5 days before surgery
Rationale: Warfarin is typically held 5 days preoperatively to allow the INR to
return to a safe range, minimizing bleeding risk during surgery. This is a
standard perioperative medication management practice. Continuing or
doubling the dose increases hemorrhage risk, while switching to enoxaparin
is not the initial priority before confirming the hold.
2. Which medication should generally be continued through the
perioperative period to prevent rebound effects?
A) Metformin
B) Beta-blocker
C) Aspirin
D) Clopidogrel
Correct Answer: Beta-blocker
Rationale: Beta-blockers are continued perioperatively to prevent
tachycardia, hypertension, and myocardial ischemia from rebound
sympathetic stimulation. Metformin is often held due to lactic acidosis risk
with contrast, while aspirin and clopidogrel are held to reduce bleeding risk.
, 3. A client with diabetes is NPO for surgery. Which intervention best
manages their blood glucose during this period?
A) Hold all insulin until the client resumes eating
B) Administer a half-dose of long-acting insulin
C) Initiate an IV insulin infusion with frequent glucose checks
D) Give oral hypoglycemic with a sip of water
Correct Answer: Initiate an IV insulin infusion with frequent glucose checks
Rationale: For NPO diabetic clients, an IV insulin infusion with frequent
glucose monitoring prevents hyperglycemia and hypoglycemia. Holding
insulin risks hyperglycemia, while giving oral agents or half-doses without
monitoring is unsafe and imprecise.
4. In the immediate postoperative period, a client's temperature
drops to 35.8°C (96.4°F). Which complication is this client at
greatest risk for?
A) Malignant hyperthermia
B) Increased blood loss
C) Surgical site infection
D) Hyperactive bowel sounds
Correct Answer: Surgical site infection
Rationale: Perioperative hypothermia causes peripheral vasoconstriction and
decreased tissue oxygenation, impairing leukocyte function and increasing
surgical site infection risk. This is an evidence-based concern supported by
surgical quality metrics.
5. A client in the PACU following abdominal surgery is restless,
thrashing, tachycardic, and hypertensive. What is the priority
nursing action?
A) Administer a PRN antiemetic
, B) Apply soft wrist restraints
C) Assess for a distended bladder
D) Administer IV normal saline
Correct Answer: Assess for a distended bladder
Rationale: Sudden restlessness, tachycardia, and hypertension in the
immediate post-op period are often caused by a distended bladder from
urinary retention. Assessing and relieving bladder distention is the priority
before considering restraints or fluid boluses.
6. A client is receiving IV morphine via PCA pump and becomes
unresponsive with a respiratory rate of 6 breaths/min. What is the
priority intervention?
A) Apply a continuous pulse oximeter
B) Push the PCA demand button to assess response
C) Administer naloxone IV and prepare to ventilate
D) Check the PCA pump settings
Correct Answer: Administer naloxone IV and prepare to ventilate
Rationale: Opioid-induced respiratory depression is a medical emergency.
Naloxone reverses opioid effects, and ventilation support is needed until it
takes effect. Checking pump settings is important but secondary to
stabilizing the client.
7. A client with diabetic neuropathy reports burning and tingling
pain in their feet. Gabapentin is prescribed. Which statement best
explains the medication's action?
A) "It blocks pain receptors in your feet directly."
B) "It reduces inflammation around the nerves."
C) "It decreases abnormal electrical activity in damaged nerves."
D) "It releases endorphins to help you cope with pain."
, Correct Answer: "It decreases abnormal electrical activity in damaged
nerves."
Rationale: Gabapentin and pregabalin are adjuvant analgesics for
neuropathic pain. They bind to alpha-2-delta subunits of calcium channels,
modulating neurotransmitter release and reducing abnormal nerve firing.
8. A client with a large, open abdominal wound has red, granular
tissue in the wound bed. Which phase of wound healing is this
client experiencing?
A) Hemostasis
B) Inflammatory phase
C) Proliferative phase
D) Maturation phase
Correct Answer: Proliferative phase
Rationale: The proliferative phase is characterized by granulation tissue (red,
granular), angiogenesis, and epithelialization. Hemostasis occurs
immediately, inflammation lasts days, and maturation involves collagen
remodeling over months.
9. A client with a serum potassium of 2.7 mEq/L is prescribed
hydrochlorothiazide for hypertension. Which nursing action is
most appropriate?
A) Administer the medication as ordered
B) Hold the medication and notify the provider
C) Double the dose to improve effectiveness
D) Give the medication with orange juice
Correct Answer: Hold the medication and notify the provider
